Ankle sprains are one of the most common sports injuries. While they often get brushed off as “just a sprain,” how an athlete manages the first few days can determine whether they’re back in the game in two weeks—or sitting out for two months.
To show why early intervention matters, let’s look at the stories of two of my recent athletes with the same injury but very different paths: Andrew and Lee.
Andrew’s Story: Early Intervention
- Day 1: Andrew injures his ankle in a game. Instead of waiting, his parents contact me immediately and I get him into the clinic that same day. After confirming there’s no fracture, I initiated a comprehensive, evidence-based treatment plan which included myofascial release, joint mobilization & manipulation, gentle range-of-motion and mobility drills, application of tape for pain and improved function, recommendations for activity modifications, and guidance on weight-bearing strategies and symptom management.
- Days 2-7: Pain decreases daily, swelling is controlled, joint mobility is returning to baseline levels, functional activities are becoming less cumbersome—not with rest, but with active recovery. Andrew initiates advanced rehabilitative work incorporating multi-directional tasks, strength training, and low-level plyometrics to facilitate a return to sport.
- Days 7-14: With professional guidance, progressive loading, and a well-designed treatment plan, Andrew is reporting nearly 100% overall recovery. He passes all return-to-play tests and is back at practice.
- Outcome: Andrew misses only 2 games, returns confidently, and lowers his risk of re-injury.
Lee’s Story: Delayed Care
- Day 1: Lee injures his ankle in a game too, but decides to “rest it and it will work itself out.” He initially avoids putting weight on it because it hurts, ices and elevates the leg when possible, and takes an advil.
- Days 2-14: Pain and swelling linger. He has lost ankle mobility and feels weak & unstable. Walking, squatting, and stairs remain difficult. He tries an OTC brace, but still cannot participate in practice at his prior level due to persistent symptoms.
- Weeks 2-3: Only now does Lee’s parent (and coach) contact me and request to begin physical therapy. Because of the delay, his ankle is stiff, weak, and unstable making it difficult for him to function in everyday and athletic activities. The initial treatment plan is similar to the above scenario, but with a much more tailored approach to restore joint range-of-motion before progressing to sport-specific drills due to significant loss of motion.
- Weeks 4–6: Lee has finally passed all required return-to-sport testing and is cleared to play (although he still demonstrated ~10% deficits on certain criteria). He’s missed nearly 1/4 of the season (including two big tournaments), his overall fitness, conditioning, and ball handling skills have dropped, and he still remains at a higher risk of a recurrent sprain.
- Outcome: Significant time loss from sport, longer rehab timeframe, higher medical costs, and lower confidence.
Why Early Intervention Makes the Difference
The body is built to heal under tailored loads and guided movement—not prolonged rest. Here’s why:
- Pain & Swelling: Early intervention and individualized load application help the body minimize swelling and reduce pain relatively quickly. Delayed care opens the window for suboptimal scar tissue formation, persistent pain, and apprehension.
- Range of Motion: Early intervention and individualized load application minimize the development of abnormal stiffness, which allows for functional activity to resume sooner. Delayed care often requires longer time and measures to regain motion and restore function.
- Strength & Stability: Early intervention and individualized load application restores strength, balance, and control during a time when fear avoidance, apprehension, and muscle inhibition are heightened. A delay in care leads to lingering problems with athletic performance and confidence in sport.
- Return to Play: Athletes who initiate care early reach functional milestones (jumping, sprinting, cutting) weeks sooner. That’s the difference between missing 1-2 games and missing out on a significant portion of the season.
- Cost: A immediate start to rehab often means fewer total visits, fewer imaging studies, and less reliance on medications—saving A LOT of money in the long run.
Practical Checklist: What To Do Within the First 48 Hours of an Ankle Sprain
✅ Get evaluated quickly by a medical professional to rule out fractures or severe injury.
✅ Use compression and elevation to limit swelling. Ice for pain.
✅ Begin gentle movement early (pain-free ROM exercises).
✅ Bear weight as tolerated—with support (brace or tape, crutches) if needed.
✅ See a sports physical therapist to start guided rehab.
✅ Avoid prolonged immobilization unless specifically directed by a provider.
The Bottom Line
Two athletes. Same injury. Two completely different outcomes.
Evidence-based, early intervention strategies are the key to returning athletes to sport quickly and safely following injury. Because every day matters.
